JP2016067719A - Instrument for artificial knee joint replacement surgery and instrument unit for artificial knee joint replacement surgery - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an instrument for artificial knee joint replacement surgery, with which the position of a desired site inside a patient body can easily be specified.SOLUTION: The instrument for artificial knee joint replacement surgery comprises: a holding mechanism 2 which includes a holding part 4 having contact parts 6 to be brought into contact with contact objects of a patient undergoing artificial knee joint replacement surgery, and which is held against the patient while the contact parts 6 are in contact with the contact objects; and an indicating mechanism 3 comprising a positional specification requiring object indicating part 18, which is attached to the holding mechanism 2 and is to be arranged in a position corresponding to the positional specification requiring object, or the site in the patient of which position needs to be specified with the holding mechanism 2 held against the patient. The position where the positional specification requiring object indicating part 18 is arranged is decided on the basis of the preoperatively determined positional relationship between the contact objects and the positional specification requiring object.SELECTED DRAWING: Figure 1

Description

  The present invention relates to an instrument used for knee replacement, and more particularly to an instrument for grasping a position of a predetermined part in a patient.

  When the artificial knee joint is attached to the patient's knee joint, the artificial knee joint is preferably attached to the patient using as an index the alignment in which the patient's femoral head center, knee joint center, and second metatarsal bone are aligned. However, since the femoral head center is located inside the human body, it is relatively difficult to confirm the position of the femoral head, and surgery may be performed in a state where the position of the femoral head center is not accurately grasped.

  In this regard, for example, Patent Document 1 discloses a femoral head center position specifying device capable of specifying the position of the femoral head center. This device has a marking plate arranged so as to cover a portion where the femoral head center is located from a direction perpendicular to the frontal plane, and a rotation shaft arranged extending in a direction perpendicular to the frontal plane. A rotation arm; and a marker attached to the rotation arm to mark an arc on the marking plate as the rotation arm rotates. In this apparatus, two arcs are recorded on the marking plate by the marker by rotating the rotating arm at each position in which the hip joint is rotated inward or outward and positioned at the first position and the second position. Is done. The center of the femoral head can be specified by the intersection of the two arcs described in this way.

Japanese Patent No. 4652481

  However, when the femoral head center is specified using the above-described apparatus, relatively complicated operations such as fixing of the marking plate to the operating table and fixing of the rotating arm to the distal end of the femur of the patient are performed as operations during the operation. Is required.

  The present invention has been made to solve the above-mentioned problems, and an object of the present invention is to provide an artificial knee joint replacement device and an artificial knee joint replacement device capable of easily specifying the position of a desired site in a human body of a patient. Is to provide a unit.

  (1) An artificial knee joint replacement device according to an aspect of the present invention for achieving the above object has a contact portion that is in contact with a contact target of a patient on whom an artificial knee joint replacement is performed. A holding mechanism that is held with respect to the patient in a state in which the contact portion is in contact with the contact target, and a position in the patient in a state in which the holding mechanism is held with respect to the patient. A position specifying target indicating unit arranged at a position corresponding to a position specifying target that is a part to be specified, and an indicating mechanism attached to the holding mechanism, and the position where the position specifying target indicating unit is arranged Is determined based on the positional relationship between the contact object and the position specifying object obtained in advance before the operation.

  In this configuration, the position specifying target instruction unit is arranged at a position corresponding to the position specifying target in a state where the touching unit is in contact with the contact target of the patient. At this time, the position specifying target instruction unit is arranged based on the relative positional relationship between the patient contact target and the position specifying target obtained in advance. Thereby, the position specifying target instruction unit can be accurately arranged at a position corresponding to the position specifying target. And since the operator who performs artificial knee joint replacement can directly look at the position specifying target instruction unit arranged as described above, the position of the position specifying target of the patient can be easily grasped.

  Therefore, in this configuration, the position of a desired part (position specifying target) in the patient's human body can be easily specified.

  (2) Preferably, the said contact part is formed with the recessed part into which the said contact object fits.

  In this configuration, the contact portion can be held in close contact with the patient.

  (3) More preferably, the holding part further includes an abutting part attaching part capable of detaching the abutting part, and the concave part of the abutting part in a state of being attached to the corresponding abutting part attaching part, The contact object is fitted.

  In this configuration, it is possible to abut the abutting portion in which the concave portion corresponding to the shape of the abutting target of the patient is formed against the abutting target of the patient. Thereby, a contact part can be more closely held with respect to a patient.

  (4) Preferably, the said recessed part is formed according to the shape of the said contact object in each said patient.

  In this configuration, the concave portion of the contact portion is formed according to the shape of the patient's contact target. Thereby, since a contact part is customized according to the shape of the contact object of each patient, it can hold | maintain a contact part still more closely with respect to a patient.

  (5) Preferably, the holding mechanism further includes a pair of the holding portions and a connecting portion that connects the pair of holding portions, and the contact portions in each of the pair of holding portions are a pair of the above-described holding portions. By holding the contact object, the holding mechanism is held with respect to the patient.

  In this configuration, the artificial knee joint replacement instrument can be easily fixed to the patient by sandwiching the patient's contact target between the pair of contact portions.

  (6) Preferably, the hole for inserting the end portion of the alignment rod is formed in the position specifying target instruction portion.

  In this configuration, an alignment rod for confirming the alignment (alignment connecting the femoral head center, the knee joint center, and the second metatarsal center in a straight line), which is important during artificial knee joint replacement, is applied to the human body. It can arrange appropriately. Specifically, the operator performs alignment in a state where the alignment rod is attached to the hole of the position specifying target indicating unit, that is, in a state where one end of the alignment rod is fixed at a position corresponding to the position of the femoral head. Can be confirmed. Thereby, it is possible to confirm appropriate alignment in which the position of the femoral head is accurately reflected.

  (7) Preferably, the contact target is an upper anterior iliac spine on either the left or right side of the patient, and the position specifying target is a femoral head of the patient's femur.

  In this configuration, the position specifying target indicating unit is based on the positional relationship between the upper anterior iliac spine and the femoral head obtained in advance before the operation in a state where the contact portion is in contact with the upper anterior iliac spine. And placed at a position corresponding to the position of the femoral head. Here, the above-mentioned superior anterior iliac spine is a portion protruding laterally in the pelvis and is a portion covered only by a very thin layer (skin etc.). That is, the relative positional relationship between the abutting portion that is in contact with the upper anterior iliac spine via this thin layer and the position specifying target indicating portion is determined between the previously obtained upper anterior iliac spine and the femoral head. The relative positional relationship is substantially the same. Thereby, the big position shift with the position of a position specific object instruction | indication part and the position of an actual femoral head can be prevented. Therefore, according to this configuration, the position of the femoral head can be accurately grasped.

  (8) More preferably, the indicating mechanism includes a proximal end portion that is a proximal end portion and a distal end portion that is a distal end portion, and the proximal end portion is attached to the holding mechanism, The distal end portion is formed to extend in a direction away from the base end portion, and the position specifying target instruction portion is provided at the distal end of the distal end portion.

  According to this structure, it becomes possible to arrange | position a position specification object part in the position corresponding to the position of the femoral head positionally distant from the upper anterior iliac spine (contact object).

  (9) More preferably, the said front-end | tip part is movable along the direction where this front-end | tip part extends with respect to the said base end part.

  In this configuration, the position of the distal end portion relative to the proximal end portion can be easily adjusted by moving the distal end portion relative to the proximal end portion. Thereby, the position of a position specification instruction | indication part can be adjusted appropriately.

  (10) Preferably, the holding mechanism further includes a universal joint portion, and the base end portion is attached to the universal joint portion.

  In this configuration, the base end portion can be rotated with respect to the holding mechanism, whereby the direction of the pointing mechanism can be easily adjusted. Thereby, the position of a position specification instruction | indication part can be adjusted appropriately.

  (11) Preferably, the contact object is an external capsule of the distal end of the radius of the patient or an internal capsule of the distal end of the tibia, and the positioning target is the second metatarsal bone of the patient.

  In this configuration, the position specifying target indicating unit is an external capsule (or an internal capsule) obtained in advance before the operation in a state in which the contact unit is in contact with the external fruit at the distal end of the radius or the internal fruit at the distal end of the tibia. And the second metatarsal, based on the positional relationship between the second metatarsal and the second metatarsal. Here, the above-mentioned outer fruit and inner fruit are the parts (so-called wrinkles) protruding laterally at the distal end of the lower limb, and are parts covered only by a very thin layer (skin etc.). That is, the relative positions of the abutting portion that is in contact with the outer fruit (or inner fruit) through this thin layer and the position specifying target indicating unit are the same as the outer fruit (or inner fruit) obtained in advance. 2 The position relative to the metatarsal bone is approximately the same. Thereby, the big position shift with the position of a position specific object instruction | indication part and the position of an actual 2nd metatarsal bone can be prevented. Therefore, according to this configuration, the position of the second metatarsal as the position specifying target can be accurately grasped.

  (12) More preferably, the holding mechanism further includes a pair of contact portions and a connection portion for connecting the pair of contact portions, wherein the one contact portion is the distal radius. The abutment part is abutted against the inner fruit of the distal end of the tibia and the abutment part is movable along the connecting part. .

  In this configuration, the prosthetic knee joint replacement instrument can be easily fixed to the patient by sandwiching the external capsule of the distal radius and the internal capsule of the distal tibia by the pair of contact portions.

  (13) More preferably, the position specifying target indicating unit is provided in the connecting unit, and the connecting unit includes a reference position corresponding to a position where the position specifying target indicating unit in the connecting unit is provided, and the connecting unit. The scale part for measuring the distance between the contact parts is formed.

  In this configuration, based on the positional relationship between the external carcass of the patient's distal end (or the internal part of the distal end of the tibia) and the second metatarsal bone obtained in advance by modeling of the patient's bone, etc. The position of the contact portion with respect to the reference position (position where the position specifying target instruction portion is provided) is adjusted. Specifically, the surgeon confirms the scale portion, and determines the distance between the reference position and the contact portion by determining the distance between the second metatarsal bone of the patient and the external capsule (or internal capsule) obtained by modeling or the like. Can be adjusted to the distance between. Thereby, the position of the position specifying target instruction unit can be accurately adjusted to the position of the second metatarsal bone.

  (14) An artificial knee joint replacement instrument unit according to a certain aspect of the present invention for achieving the above object is a femoral head as an artificial knee joint replacement instrument whose position specifying target is the femoral head of a patient's femur. A position determining instrument, and a second metatarsal position determining instrument as an artificial knee joint replacement instrument whose positioning target is the patient's second metatarsal bone.

  According to this configuration, alignment can be confirmed using the alignment rod in a state where both the femoral head position determining device and the second metatarsal position determining device are fixed to the patient during and after the operation. Specifically, in a state where both instruments are fixed to the patient, the surgeon determines each of both ends of the alignment rod, the position specifying target instruction unit of the femoral head position determining instrument, and the second metatarsal position determination. It arrange | positions so that it may overlap with the position specific object instruction | indication part of an instrument. At this time, if the knee joint center overlaps the alignment rod, it can be confirmed that the femoral head center, the knee joint center, and the second metatarsal center are in a straight line, that is, alignment is achieved. On the other hand, if the alignment rod and the knee joint center are misaligned, it can be confirmed that the alignment is not achieved, and the necessity of re-osteotomy can be determined according to the misalignment amount.

  According to the present invention, it is possible to easily specify the position of a desired part (position specifying target) in a patient's human body.

It is a perspective view of the femoral head position determination instrument concerning an embodiment. It is the figure which looked at the femoral head position determination instrument shown in FIG. 1 from the front. It is the figure which looked at the femoral head position determination instrument shown in FIG. 1 from the side. FIG. 4 is an arrow view of the femoral head position determining instrument shown in FIG. 3 as viewed from the direction of arrow IV, with the left part of the instrument omitted. It is a figure which shows the state which fixed the femoral head position determination instrument shown in FIG. 1 with respect to the patient, Comprising: It is the figure seen from the front of a patient. FIG. 6 is a perspective view of the femoral head position determining instrument in the state shown in FIG. 5. It is the figure which looked at the femoral head position determination instrument of the state shown in FIG. 5 from the patient's side. It is the figure which looked at the femoral head position determination instrument of the state shown in FIG. 5 from the front of a patient, Comprising: It is a figure which shows the state in which the alignment rod was attached to the femoral head position determination instrument. It is a perspective view of the femoral head position determination instrument concerning a modification. It is a perspective view of the femoral head position determination instrument concerning a modification. It is a perspective view of the 2nd metatarsal bone position determination instrument concerning an embodiment. It is a side view of the 2nd metatarsal bone position determination instrument shown in FIG. It is a figure which shows the state which fixed the artificial knee joint replacement instrument unit which concerns on embodiment with respect to the patient. It is the model which showed the state of the patient's knee joint before and after performing knee joint replacement, (A) is the figure which shows the state of the patient's knee joint before performing knee replacement, (A) is a figure which shows the state of the patient's knee joint after performing artificial knee joint replacement.

  FIGS. 1 to 4 are views showing the configuration of a femoral head position determining device 1 (artificial knee joint replacement device) according to an embodiment of the present invention. FIG. 1 is a perspective view, and FIG. FIG. 3 is a side view, FIG. 4 is an arrow view of the femoral head position determining device 1 shown in FIG. 3 viewed from the direction of arrow IV, and the left portion of the device 1 is omitted. It is a figure shown. FIGS. 5 to 7 are views showing a state in which the femoral head positioning device 1 is fixed to the patient P (only the bone portion is shown), and FIG. 5 is a view as seen from the front of the patient P. 6 is a perspective view, and FIG. 7 is a side view. In addition, for each drawing described below, for convenience of explanation, the direction indicated by the arrow indicated above is indicated as upper or upward, the direction indicated by the arrow indicated as lower is indicated as lower or lower, and the front. The direction indicated by the arrow indicates the direction indicated by the front or front, the direction indicated by the arrow indicated as rear, the rear or rear, the direction indicated by the arrow indicated as right, the direction indicated by the arrow indicated as right and left Called the left side. Moreover, the up-down direction, the front-rear direction, and the left-right direction in each figure correspond to the up-down direction, the front-rear direction, and the left-right direction of the human body of the patient P, respectively.

  The femoral head position determining device 1 according to the present embodiment is used in artificial knee joint replacement. The artificial knee joint replacement is an operation in which a knee joint of a patient whose knee joint is highly deformed due to, for example, knee osteoarthritis or rheumatoid arthritis is replaced with an artificial knee joint. FIG. 14 is a schematic view showing the state of the knee joint of the patient P before and after performing the knee replacement, and FIG. 14A shows the state of the knee joint of the patient P before the knee replacement. (B) is a figure which shows the state of the knee joint of the patient P after performing artificial knee joint replacement. As shown in FIG. 14A, in the patient P whose knee joint is deformed, the center of the head 56 of the femur 55 of the patient P, the center of the knee joint, and the second metatarsal bone are not aligned. By performing artificial knee joint replacement on this patient P, the center of the head 56, the center of the knee joint, and the second metatarsal become straight, and the knee of the patient P as shown in FIG. 14 (B). The joint can be in an appropriate state. In total knee arthroplasty, the distal end of the femur and the proximal end of the tibia in the patient's knee joint are cut at an appropriate cut surface, and then the femoral implant and the tibial implant are placed on the cut surface. The

  When the distal end of the femur and the proximal end of the tibia are cut at appropriate positions as described above, the center of the head 56 of the femur 55 of the patient P, the knee, when each implant is placed on the cut surface after cutting. The center of the joint and the second metatarsal bone are preferably aligned. However, since the femoral head 56 is located inside the human body, it is relatively difficult to confirm the position, and the operation may be performed in a state where the position of the femoral head 56 is not accurately grasped. If it does so, an artificial knee joint will not be installed in an appropriate state.

  On the other hand, according to the femoral head position determining instrument 1 according to this embodiment, the position of the center of the femoral head of the patient P can be grasped relatively easily, so that the artificial knee joint is installed in an appropriate state. It becomes possible. Below, the structure and usage method of the said femoral head position determination instrument 1 are demonstrated in order.

[overall structure]
As shown in FIGS. 1 to 4, the femoral head position determining instrument 1 includes a holding mechanism 2 and an instruction mechanism 3.

  The holding mechanism 2 includes a pair of holding portions 4 and 4, a pair of universal joint portions 20, and a connecting portion 30.

  The pair of holding portions 4 and 4 have the same structure. Each holding portion 4 includes a contact plate mounting portion 5 (contact portion mounting portion) and a contact plate 6 (contact portion).

  The contact plate mounting portion 5 is a portion formed in a substantially plate shape having a predetermined thickness in the left-right direction, and is formed in a rectangular shape when viewed from the left-right direction. The contact plate mounting portion 5 has an accommodation recess 5a formed on one surface in the thickness direction. The accommodating recess 5a is formed in a concave shape in which the contact plate 6 is accommodated. The housing recess 5a is formed on the inner surface of the pair of contact plate mounting portions 5 provided to face each other. The accommodation recess 5a is formed so as to open upward and inward in the femoral head positioning instrument 1.

  A hole (not shown) extending from the front surface of the contact plate mounting portion 5 to the rear side is formed in the contact plate mounting portion 5, and a box of the universal joint portion 20, which will be described in detail later, is formed in the hole portion. The rod-shaped part 7 provided integrally with the part 21 is inserted (see FIG. 3). Although illustration is omitted, the femoral head position determining instrument 1 has a fixing mechanism for fixing the rod-like portion 7 to the contact plate attaching portion 5. Examples of the fixing mechanism include a mechanism using a screw or a ball plunger, but are not limited to this and may have other configurations.

  The contact plate 6 is a member that is formed in a plate shape that is smaller than the contact plate mounting portion 5 and is thinner. The length of the contact plate 6 in the up-down direction, the length in the left-right direction, and the thickness in the front-rear direction are respectively the length in the up-down direction, the length in the left-right direction, and the depth in the front-rear direction of the receiving recess 5a. It is almost the same as each. Thereby, the contact plate 6 can be attached to and detached from the housing recess 5 a of the contact plate mounting portion 5.

  On one surface of the contact plate 6, a pelvic recess 6 a (contact target recess) is formed. The pelvic recess 6a is formed in a curved and elongated groove shape. The contact plate 6 is housed and fixed in the contact plate mounting portion 5 so that the pelvic recess 6a faces inward.

  The contact plate 6 is manufactured in accordance with the patient P to be operated. Specifically, the abutment plate 6 is configured so that the pelvic recess 6a is formed so that the upper anterior iliac spine 52 (patient) of the patient P when the femoral head positioning device 1 is attached to the patient P (see FIG. 5 and the like). The iliac bone 51 of the P pelvis 50 is formed in a shape that fits into a portion protruding outward in the left-right direction (see FIG. 6). More specifically, the pelvic recess 6a of the right contact plate 6 is formed into a shape that fits into the upper anterior iliac spine 52 on the right side of the patient P, while the pelvis recess of the left contact plate 6 is used. The recess 6 a is formed in a shape that fits into the upper anterior iliac spine 52 on the left side of the patient P. Thereby, the femoral head position determining instrument 1 can be fitted to the patient P.

  Although not shown in FIGS. 1 to 4, etc., the holding portion 4 is configured so that the contact plate 6 in the state of being accommodated in the accommodation recess 5 a of the contact plate attachment portion 5 is the contact plate attachment portion 5. And a fixing mechanism for fixing to. Examples of the fixing mechanism include a mechanism for fixing the contact plate 6 to the contact plate mounting portion 5 using, for example, a screw or a claw-shaped portion. Good.

  The instruction mechanism 3 has a pair of extending portions 10 and 10. A pair of extension parts 10 and 10 are mutually the same structure. Each extending part 10 is provided so that the base end side is rotatably attached to each holding part 4 via the universal joint part 20, while the distal end side extends in a direction away from the holding part 4. The extending portion 10 has a proximal end portion 11 that is a proximal end portion and a distal end portion 15 that is a distal end portion.

  The base end portion 11 includes a base portion 12 and a rod-like portion 13 that are integrally formed.

  The base portion 12 is a portion that functions as a yoke portion of the universal joint portion 20, which will be described in detail later. The base portion 12 is rotatable about the first shaft portion 26 of the universal joint portion 20, and the second portion of the universal joint portion 20. The shaft 28 is rotatable with respect to the second shaft 28 with the shaft 28 as an axis.

  The rod-shaped portion 13 is a rod-shaped portion whose one end side is provided integrally with the base portion 12. The rod-shaped part 13 is formed so that the cross-sectional shape is substantially rectangular. Line-shaped scale lines 14 a, 14 a,... Extending in a direction perpendicular to the longitudinal direction of the rod-shaped portion 13 are provided on the side surface of the rod-shaped portion 13 at equal intervals along the longitudinal direction of the rod-shaped portion 13. Yes. These scale lines 14 a, 14 a,... Constitute an extension part scale part 14 that serves as an index indicating the length of the extension part 10. The rod-like portion 13 is inserted through a hole (not shown) formed in the distal end portion 15 of the extending portion 10.

  The distal end portion 15 is provided so as to be slidable along the longitudinal direction of the rod-shaped portion 13. The tip portion 15 has a slide portion 16 and a hook-like portion 17.

  The slide part 16 is a part formed in an elongated and substantially cylindrical shape. A rod-like portion 13 is inserted into a hole formed inside the slide portion 16. In the extending portion 10, the slide portion 16 slides along the longitudinal direction of the rod-shaped portion 13 while the inner circumferential surface of the slide portion 16 slides with respect to the outer circumferential surface of the rod-shaped portion 13. Thereby, the extension part 10 can be expanded-contracted in a longitudinal direction. Although not shown in the drawings, the extending portion 10 is provided with a fixing mechanism, and the distal end portion 15 is fixed to the proximal end portion 11 and the distal end relative to the proximal end portion 11 as necessary. The state where the fixing of the part 15 is released can be switched. The fixing mechanism can be configured using, for example, a screw or a ball plunger.

  The bowl-shaped portion 17 is formed in a bowl shape having a shape obtained by cutting off a half of the hollow sphere, and the opening thereof opens in the extending direction of the slide portion 16. The hook-like portion 17 is fixed to the distal end portion of the slide portion 16.

  Inside the bowl-shaped portion 17, a ball-shaped member that cannot be detached from the bowl-shaped portion 17 and is rotatable with respect to the bowl-shaped portion 17 is accommodated. This ball-shaped member is a bone head position indicating unit 18 (position specifying target indicating unit) that indicates a position corresponding to the position of the femoral head 56 of the patient P in a state where the femoral head position determining instrument 1 is mounted on the patient P. ). The bone head position indicating portion 18 is formed with a mounting hole portion 18a to which a distal end portion of an alignment rod 60, which will be described in detail later, is attached. The mounting hole 18 a is exposed from the opening of the flange 17.

  The pair of universal joint portions 20 have the same structure. The universal joint portion 20 includes a box portion 21, a first shaft portion 26, a second shaft portion 28, and the base portion 12 of the extending portion 10 described above.

  The box part 21 has four wall parts 22, 23, 24, 25 formed in a square shape in plan view, and these are integrally formed. Specifically, as shown in FIG. 1 and the like, the box portion 21 has an upper side wall portion 22, a rear side wall portion 23, an inner side wall portion 24, and an outer side wall portion 25, which are integrally formed. . That is, the box part 21 is formed in a substantially box shape with the lower side and the front side opened. The holding part 4 is attached to the rear side wall part 23 via the rod-like part 7 (see FIG. 3), and the connecting part 30 is fixed to the inner side wall part 24. The inner wall portion 24 is a wall portion on the side where the connecting portion 30 is provided among the wall portions constituting each box portion 21, and the outer wall portion 25 is a wall portion constituting each box portion 21. It is a wall part on the opposite side to the side in which the connection part 30 is provided.

  The above-described rod-like portion 7 is integrally provided on the rear side wall portion 23. The rod-like portion 7 is formed so as to extend rearward from the rear side wall portion 23, and a tip side portion thereof is inserted into a hole portion formed in the contact plate attaching portion 5 of the holding portion 4. The hole is slidable with respect to the rod-shaped portion 7 along the longitudinal direction of the rod-shaped portion 7. Thereby, the clearance gap G (refer FIG. 3) between the holding | maintenance part 4 and the universal joint part 20 can be adjusted.

  Further, on the side surface of the rod-like portion 7, line-shaped scale lines 8a, 8a,... Extending in the direction perpendicular to the longitudinal direction of the rod-like portion 7 are provided at equal intervals along the longitudinal direction of the rod-like portion 7. It has been. These scale lines 8 a, 8 a,... Constitute a gap scale portion 8 that serves as an index indicating the length of the gap G between the holding portion 4 and the universal joint portion 20.

  The first shaft portion 26 is a shaft portion provided so as to extend in the left-right direction, and is provided to be rotatable with respect to the inner wall portion 24 and the outer wall portion 25 of the box portion 21. An outer end portion of the first shaft portion 26 is provided so as to protrude outward from the outer wall portion 25. A first angle scale portion 27 is formed on the surface of the portion viewed from the outside. The first angle scale portion 27 is for grasping an angle with respect to the vertical direction of the extending portion 10 (hereinafter also referred to as a first angle) when viewed from the left-right direction. Specifically, referring to FIG. 3, when the extending portion 10 is rotated with respect to the box portion 21 with the first shaft portion 26 as the central axis, the first angle scale portion 27 is also rotated with the box portion 21. Rotate against. And the angular position (not shown) attached to the scale line 27a of the first angle scale part 27 that is aligned with the first angle indicating line 25a formed on the outer wall part 25 of the box part 21 extends. This is the first angle of the portion 10.

  In addition, although illustration is abbreviate | omitted, the universal joint part 20 has the fixing mechanism for fixing the extension part 10 which rotates centering on the 1st axial part 26 at each 1st angular position. In the fixing mechanism, for example, as an example, a ball portion of a ball plunger (not shown) is fitted into each of a plurality of recesses (not shown) arranged in an annular shape along the outer peripheral surface of the first shaft portion 26. It can be configured. However, the configuration of the fixing mechanism is not limited to this. For example, the fixing mechanism may be configured by using a screw or the like.

  The second shaft portion 28 is a shaft portion provided so as to extend in a direction perpendicular to the first shaft portion 26, and is fixed to the first shaft portion 26. The extending part 10 is provided so as to be rotatable about the central axis of the second shaft part 28 with respect to the second shaft part 28. As shown in FIG. 4, a second angle scale portion 29 is formed in a portion of the second shaft portion 28 that is exposed to the outside of the extending portion 10. The second angle graduation portion 29 is a direction d perpendicular to both the central axis of the first shaft portion 26 and the second shaft portion 28 of the extension portion 10 when viewed from the axial direction of the second shaft portion 28. This is for grasping an angle with respect to (hereinafter also referred to as a second angle). Specifically, referring to FIG. 4, when the extension portion 10 is rotated about the second shaft portion 28 as a central axis, the second angle indicating line 12 a formed on the base portion 12 of the extension portion 10 and a straight line shape are formed. The angular position (not shown) attached to the scale line 29 a of the second angle scale portion 29 thus becomes the second angle of the extending portion 10.

  In addition, although illustration is abbreviate | omitted, the universal joint part 20 has the fixing mechanism for fixing the extension part 10 rotated centering on the 2nd axial part 28 in each 2nd angular position. In the fixing mechanism, for example, as an example, a ball portion of a ball plunger (not shown) is fitted in each of a plurality of recesses (not shown) arranged in an annular shape along the outer peripheral surface of the second shaft portion 28. It can be configured. However, the configuration of the fixing mechanism is not limited to this. For example, the fixing mechanism may be configured by using a screw or the like.

  The connecting portion 30 connects the pair of holding portions 4 in a state where the distance between the pair of holding portions 4 is maintained by connecting the pair of box portions 21 to each other. The connecting portion 30 has a right side portion 31 and a left side portion 35.

  The right portion 31 is a portion formed in a substantially cylindrical shape extending in the left-right direction. The right end portion of the right portion 31 is provided integrally with the inner wall portion 24 of the right box portion 21. Further, a rod-shaped portion 37 of the left side portion 35 described later in detail is inserted into the inner peripheral surface of the right side portion 31.

  The left side portion 35 has a base portion 36 and a rod-like portion 37, which are integrally formed. The base portion 36 is a portion formed in a column shape extending in the left-right direction. The length of the base portion 36 in the left-right direction is shorter than the length of the right side portion 31 in the left-right direction.

  The rod-shaped portion 37 is a rod-shaped portion whose one end is provided integrally with the base portion 36. The rod-shaped part 37 is formed so that the cross-sectional shape is substantially rectangular. Line-shaped scale lines 38 a, 38 a,... Extending in a direction perpendicular to the longitudinal direction of the rod-shaped portion 37 are provided at equal intervals along the longitudinal direction of the rod-shaped portion 37 on the side surface of the rod-shaped portion 37. Yes. These scale lines 38 a, 38 a,... Constitute a connection part scale part 38 that serves as an index indicating the length of the connection part 30. The rod-shaped portion 37 is inserted through the inner peripheral surface of the right side portion 31.

  In the connecting portion 30 having the above-described configuration, the connecting portion 30 can be expanded and contracted in the longitudinal direction by sliding the other of the right portion 31 and the left portion 35 in the left-right direction. Although not shown in the drawings, the connecting portion 30 is provided with a fixing mechanism, and if necessary, the right portion 31 and the left portion 35 are fixed to each other, and the right portion 31 and the left portion 35 are connected to each other. It is possible to switch between the states in which the fixation to each other is released. The mechanism can be configured using, for example, a screw, a ball plunger, or the like.

[how to use]
In using the femoral head position determining instrument 1 according to the present embodiment, first, the contact plate 6 that matches the patient P to be operated is manufactured. Specifically, first, the bone shape near the pelvis of the patient P is modeled by X-ray, MRI (Magnetic Resonance Imaging), 3D-CT (3 Dimensional-Computed Tomography) or the like. Then, based on the model, one contact plate 6 is formed with a pelvic recess 6a having a shape complementary to the shape of the upper anterior iliac spine 52 on the right side of the patient P, while the other contact plate 6, a pelvic recess 6 a having a shape complementary to the shape of the left upper anterior iliac spine 52 of the patient P is formed. Each contact plate 6 formed in this way is housed and fixed in the housing recess 5 a of the corresponding contact plate mounting portion 5.

  Next, the surgeon fixes the femoral head position determining instrument 1 to which the contact plate 6 formed as described above is attached to the patient P. Specifically, the surgeon fits the right upper anterior iliac spine 52 of the patient P into the pelvic recess 6a of the right abutment plate 6 and the left upper anterior iliac spine 52 is on the left side. The length in the left-right direction of the femoral head position determining instrument 1 is adjusted so that it fits into the pelvic recess 6 a of the contact plate 6. At that time, the surgeon appropriately slides one of the left and right portions 31 and 35 of the connecting portion 30 in the left and right directions with respect to the other portion 35 and 31, and the pair of holding portions 4 supports the upper and lower sides of the patient P After holding the iliac spine 52 in between, the portions 31 and 35 of the connecting portion 30 are fixed to each other by a fixing mechanism. Thereby, the holding mechanism 2 can be fixed to the patient P.

  At this time, the surgeon can compare the length of the connecting portion 30 indicated by the connecting portion scale portion 38 with the bone shape of the patient modeled by an X-ray or the like. That is, the surgeon can use the connecting portion scale portion 38 for confirmation. Further, when the holding mechanism 2 is fixed to the patient P as described above, the patient P is adjusted by adjusting the gap G between the holding part 4 and the universal joint part 20 according to the size and shape of the patient's abdomen. The femoral head positioning device 1 can be fixed to the patient P without interfering with the abdomen.

  Next, the surgeon arranges the head position indicating unit 18 provided at the distal end portion of the extending portion 10 at the position of the femoral head 56 of the patient P when the patient P is viewed from the front side. Specifically, based on the positional relationship between the upper anterior iliac spine 52 of the patient P and the femoral head 56 obtained in advance by modeling of the bone shape of the patient, the surgeon performs the first angle, the second angle, By adjusting the gap G and the length of the extending part 10, the position of the head position indicating part 18 is adjusted to the position of the femoral head 56. At this time, the operator can accurately adjust the lengths of the first angle, the second angle, the gap G, and the extension portion 10 described above while checking the scale portions 8, 14, 27, and 29. The position of the head position indicating unit 18 can be accurately adjusted to the position of the femoral head 56.

  Next, the surgeon attaches the distal end portion of the alignment rod 60 to the attachment hole portion 18a of the head position indicating portion 18 disposed at a position corresponding to the position of the femoral head 56 as described above. Thereby, the operator can confirm the alignment while changing the direction of the alignment rod 60 around the bone head position indicating unit 18 (see FIG. 8).

  Then, the operator confirms the alignment as described above, so that the knee joint center, the knee joint center, and the second metatarsal of the patient are aligned after the artificial knee joint is mounted. The position of the cutting plane (specifically, the distal end of the femur and the proximal end of the tibia) can be determined. Thereby, the cut surface in which an artificial knee joint is installed can be formed appropriately.

[effect]
As described above, according to the femoral head position determining device 1 according to the present embodiment, the head position indicating unit 18 can be used in the state where the contact plate 6 is in contact with the upper anterior iliac spine 52 of the patient. 56 is arranged at a position corresponding to 56. At this time, the bone head position indicating unit 18 is arranged based on the relative positional relationship between the upper anterior iliac spine 52 of the patient P and the femoral head 56 obtained from the bone shape model of the patient P by X-ray or the like. . Thereby, the bone head position instruction | indication part 18 can be correctly arrange | positioned in the position corresponding to the femoral head 56. FIG. Since the operator who performs artificial knee joint replacement can directly view the head position indicating unit 18 arranged as described above, the position of the femoral head 56 of the patient can be easily grasped.

  Therefore, according to the femoral head position determining instrument 1, the position of the femoral head 56 of the patient P can be easily specified. In addition, since the position of the head position indicating unit 18 determined as described above is a position that accurately corresponds to the position of the femoral head 56, alignment can be obtained with high accuracy.

  Further, according to the femoral head position determining instrument 1, the contact plate 6 is formed with the pelvic recess 6a into which the upper anterior iliac spine 52 is fitted, so that the contact plate 6 is closely attached to the patient P. Can be held.

  Further, according to the femoral head position determining instrument 1, the contact plate 6 in which the pelvic recess 6 a corresponding to the shape of the upper anterior iliac spine 52 of the patient P is formed is attached to the upper anterior iliac spine 52 of the patient P. It abuts against. Thereby, the contact plate 6 can be held in close contact with the patient P.

  Further, according to the femoral head position determining instrument 1, the abutting plate 6 is manufactured in accordance with the upper anterior iliac spine 52 of the patient P, but other parts (the abutting plate 6 in the femoral head positioning instrument 1). It is not necessary to change depending on the patient P. That is, according to the femoral head position determination instrument 1, since there are few parts manufactured according to the patient P, the instrument according to the patient P can be prepared at low cost and in a short time.

  Further, according to the femoral head position determining instrument 1, the pelvic recess 6 a of the contact plate 6 is manufactured according to the shape of the upper anterior iliac spine 52 of the patient P. Thereby, since the contact plate 6 is customized according to the shape of the upper anterior iliac spine 52 of each patient P on which surgery is performed, the contact plate 6 is held more closely to the patient P. Can do.

  Further, according to the femoral head position determining instrument 1, the contact plate 6 manufactured for the patient P is stored, so that when the patient P needs revision surgery, The decision instrument 1 can be reused.

  Further, according to the femoral head position determining instrument 1, the instrument 1 can be easily fixed to the patient P by sandwiching the upper anterior iliac spine 52 of the patient P between the pair of holding portions 4.

  Further, according to the femoral head position determining device 1, the alignment (alignment connecting the femoral head center, the knee joint center, and the second metatarsal center in a straight line) that is important in the artificial knee joint replacement is confirmed. Therefore, the alignment rod 60 can be appropriately disposed with respect to the patient P. Specifically, the surgeon is fixed in a state where the alignment rod 60 is attached to the attachment hole 18 a of the head position indicating unit 18, that is, one end of the alignment rod 60 corresponds to the position of the femoral head 56. In the state, alignment can be confirmed. Thereby, appropriate alignment in which the position of the femoral head 56 is accurately reflected can be confirmed.

  Further, according to the femoral head position determining instrument 1, since the head position indicating unit 18 is rotatable with respect to the hook-shaped part 17, the operator can attach the end of the alignment rod 60 to the attachment hole of the head position indicating unit 18. The orientation of the alignment rod 60 can be easily changed while attached to the portion 18a.

  Further, according to the femoral head position determining instrument 1, after the artificial knee joint is attached to the knee joint of the patient P, one end of the alignment rod 60 is attached to the attachment hole 18a to change the orientation of the alignment rod 60. It can be easily confirmed that the center of the femoral head 56 of the patient P, the center of the knee joint, and the second metatarsal bone are in a straight line.

  Further, according to the femoral head position determining instrument 1, the head position indicating unit 18 is obtained in advance before the operation in a state where the contact plate 6 of the holding unit 4 is in contact with the upper anterior iliac spine 52. Based on the positional relationship between the anterior iliac spine 52 and the femoral head 56, it is arranged at a position corresponding to the position of the femoral head 56. Here, the upper anterior iliac spine 52 is a portion protruding laterally in the pelvis 50 and is a portion covered only by a very thin layer (skin etc.). That is, the relative positional relationship between the abutment plate 6 that is in contact with the upper anterior iliac spine 52 via this thin layer and the head position indicating unit 18 is determined in advance. The relative positional relationship with the head 56 is substantially the same. Thereby, the big position shift with the position of the head position instruction | indication part 18 and the actual position of the femoral head 56 can be prevented. Therefore, according to the femoral head position determining instrument 1, the position of the femoral head 56 can be accurately grasped.

Further, according to the femoral head position determining instrument 1, the position of the femoral head 56 is indicated by the distal end of the extending portion 10 of the indicating mechanism 3 formed so as to extend from the proximal end side to the distal end side. This
It is possible to dispose the bone head position indicating unit 18 at a position corresponding to the position of the femoral head 56 that is distant from the superior anterior iliac spine 52 as a contact target.

  Further, according to the femoral head position determining instrument 1, the position of the distal end portion 15 relative to the proximal end portion 11 can be easily adjusted by moving the distal end portion 15 relative to the proximal end portion 11 of the extending portion 10. it can. Thereby, the position of the bone head position instruction | indication part 18 can be adjusted appropriately.

  Further, according to the femoral head position determining instrument 1, the universal joint portion 20 can rotate the proximal end portion 11 of the extension portion 10 with respect to the holding mechanism 2, and thereby the orientation of the extension portion 10 can be changed. It can be adjusted easily. Thereby, the position of the bone head position instruction | indication part 18 can be adjusted appropriately.

  Although the embodiments of the present invention have been described above, the present invention is not limited to the above-described embodiments, and various modifications are possible as long as they are described in the claims. For example, the following modifications may be made.

[Modification]
(1) FIG. 9 is a perspective view of a femoral head position determining instrument 1a according to a modification. In the femoral head position determining instrument 1 according to the above-described embodiment, the instrument 1 is fixed to the patient P by sandwiching the upper anterior iliac spine 52 of the patient P from both sides by the pair of holding portions 4. Not limited to. For example, as shown in FIG. 9, a femoral head position determining device 1 a including a holding mechanism 2 a having one holding portion 4 can be configured. In the femoral head positioning device 1a, the contact plate 6 of the holding unit 4 is in contact with one of the upper anterior iliac spines 52 of the patient P and is supported by an operator or an assistant (or another It is used in a state of being supported by a support device). According to the femoral head position determining instrument 1a, the femoral head position determining instrument 1a is troublesome in that it is supported by an operator or supported by another instrument during use, but compared with the femoral head position determining instrument 1 described above. Thus, the configuration can be greatly simplified and the product can be downsized. Specifically, as compared with the femoral head position determining instrument 1 described above, the one holding portion 4, the one extending portion 10, the connecting portion 30, and the like can be omitted.

  (2) FIG. 10 is a perspective view of a femoral head position determining instrument 1b according to a modification. In the femoral head position determining instrument 1 according to the above-described embodiment, the abutment plate 6 is detachable from the abutment plate mounting portion 5, but the configuration is not limited thereto. Specifically, as shown in FIG. 10, the holding portion 4a may be configured by a single plate-like member. Thereby, it is possible to save the trouble of manufacturing a part (contact plate 6 in the case of the femoral head position determining instrument 1 shown in FIG. 1) for each patient P, and the holding mechanism 2b that can handle all patients P is provided. Equipment can be provided. In this case, a portion of each holding portion 4a facing the counterpart holding portion 4a functions as an abutting portion on which the patient's upper anterior iliac spine abuts.

  (3) FIG. 11 is a perspective view of the second metatarsal bone position determining instrument 1c according to the embodiment. FIG. 12 is a side view of the second metatarsal bone position determining instrument 1c shown in FIG. In the embodiment and the modification described above, the femoral head position determining devices 1, 1a and 1b for grasping the position of the femoral head 56 have been described as an example of an artificial knee joint replacement device. Another example of the device for use is the second metatarsal bone position determining device 1c shown in FIGS. 11 and 12. The second metatarsal position determining instrument 1c is used by the operator to grasp the position of the patient's second metatarsal bone.

[overall structure]
As shown in FIGS. 11 and 12, the second metatarsal bone position determining instrument 1c includes a holding mechanism 2c and an instruction mechanism 3a.

  The holding mechanism 2 c includes a pair of holding portions 40 and 40 and a connecting portion 45.

  A pair of holding | maintenance parts 40 and 40 are mutually the same shape. Each holding portion 40 has a contact plate attachment portion 41 (contact portion attachment portion) and a contact plate 42 (contact portion), as in the case of the above-described embodiment.

  The contact plate mounting portion 41 is a portion formed in a substantially plate shape having a predetermined thickness in the left-right direction, like the contact plate mounting portion 5 of the femoral head position determining instrument 1 shown in FIG. In this part, an accommodation recess 41a for accommodating the contact plate 42 is formed.

  In addition, the contact plate mounting portion 41 is fitted with a groove portion 45a formed in a connecting portion 45, which will be described later in detail, and is formed with a ridge portion 43 that is slidable in the left-right direction along the groove portion 45a. . The protrusion 43 is formed to extend along the left-right direction.

  Similar to the contact plate 6 of the femoral head position determining instrument 1 shown in FIG. 1, the contact plate 42 is formed to have a size that can be attached to and removed from the storage recess 41a of the contact plate mounting portion 41, and the storage recess 41a. Can be desorbed. Further, the contact plate 42 is formed with a heel recess 42a (a contact target recess) into which the patient's heel fits in a state in which the second metatarsal bone position determining device 1c is fixed to the ankle of the patient. Yes. The contact plate 42 is housed and fixed in the contact plate mounting portion 41 such that the flange recess 42a faces inward.

  The contact plate 42 is manufactured according to the patient on whom the operation is performed. Specifically, the abutment plate 42 is configured such that, in a state where the second metatarsal bone position determining device 1c is attached to the patient's ankle, the heel recess 42a is formed so that the patient's heel Alternatively, it is formed into a shape that fits into the outer cusp of the distal end of the tibia. More specifically, the ridge recess 42a of the right abutment plate 42 is formed in a shape that fits into either the inner fruit or the outer fruit, while the heel recess 42a of the left abutment plate 42 is formed. Is formed into a shape that fits into the other of the inner fruit and outer fruit. Thereby, the 2nd metatarsal bone position determination instrument 1c can be fitted with respect to a patient.

  Furthermore, the contact plate 42 is manufactured as follows according to the bone shape near the ankle of the patient. Specifically, the contact plate 42 is arranged so that the position of the second metatarsal bone of the patient sandwiched between the contact plates 42 coincides with the position of an instruction mechanism 3a described later in detail in the left-right direction. ,It is formed.

  The connecting portion 45 is a member formed in a long shape extending in the left-right direction, and a groove portion 45a into which the protruding portion 43 of the contact plate 42 is fitted is formed so as to extend in the longitudinal direction. In addition, an instruction mechanism 3 a is fixed to a central portion of the connecting portion 45 in the longitudinal direction (left-right direction). Further, the connecting portion 45 includes a right scale portion 46 for measuring a distance between the reference position and the right holding portion 40 with the portion where the pointing mechanism 3a is fixed as a reference position, and the reference position. And a left scale portion 47 for measuring the distance between the left holding portion 40 and the left holding portion 40 is formed.

  The instruction mechanism 3a is fixed to the central portion of the connecting portion 45 in the left-right direction. The indication mechanism 3a is housed in the protrusion 3b protruding forward from the front surface of the connecting portion 45, the hook-like portion 17 provided in the upper portion of the tip of the protrusion 3b, and the hook-like portion 17. And a ball-shaped member. The ball-shaped member is provided with a second metatarsal position indicating unit 18b (position specifying) that indicates the position of the second metatarsal of the patient in a state where the second metatarsal position determining device 1c is mounted on the patient. Target instruction unit). In the second metatarsal position indicating portion 18b, a mounting hole portion 18a to which the distal end portion of the alignment rod 60 is attached is formed as in the case of the above embodiment. In addition, the shape of the hook-shaped part 17 in the second metatarsal position determining device 1c is the same as the shape of the hook-shaped part 17 in the above-described femoral head position determining device 1, and the second metatarsal position determining unit 1c. Since the shape of 18b is the same as the shape of the head position indicating unit 18 in the femoral head position determining instrument 1 described above, detailed description thereof is omitted.

[how to use]
In using the second metatarsal bone position determining device 1c according to the present embodiment, first, as in the case of the femoral head position determining device 1 described above, the contact plate 42 is manufactured according to the patient on which the operation is performed. . Specifically, first, a bone shape near the ankle of the patient is modeled by an X-ray or the like, and each of the pair of contact plates 42 is formed based on the model. At this time, each contact plate 42 is in a state in which the patient's inner fruit or outer fruit fits in the heel recess 42a formed in each contact plate 42, and the position of the pointing mechanism 3a in the left-right direction is In order to coincide with the position of the second metatarsal. Each of the contact plates 42 formed in this way is housed and fixed in the housing recess 41 a of the corresponding contact plate mounting portion 41.

  Next, the surgeon fixes the second metatarsal bone position determining device 1c to which the contact plate 42 formed as described above is attached to the patient. Specifically, the operator slides the position of one holding part 40 with respect to the connecting part 45 while confirming the right scale part 46 (or the left scale part 47), and near the ankle of the modeled patient. It adjusts to the distance between the 2nd metatarsal bone in the left-right direction of a patient calculated based on the bone shape, and the internal or external fruit. In a state where the patient's heel is fitted in the heel recess 42a of the one holding portion 40 thus adjusted in distance, the other holding portion 40 is slid inward to sandwich the patient's heel from both sides. Thereby, while being able to fix the 2nd metatarsal position determination instrument 1c with respect to a patient's ankle, the position of the 2nd metatarsal position instruction | indication part 18b can be exactly matched with the position of a patient's 2nd metatarsal bone. it can.

  Next, the operator attaches the distal end portion of the alignment rod 60 to the attachment hole portion 18a of the second metatarsal position indicating portion 18b arranged at the position of the second metatarsal as described above. Thereby, the surgeon can confirm the alignment while changing the direction of the alignment rod 60 around the second metatarsal position indicating portion 18b.

  Then, the operator can determine the position of the cut surface of the knee joint (specifically, the distal end of the femur and the proximal end of the tibia) while confirming the alignment as described above. The cut surface to be formed can be appropriately formed.

[effect]
As described above, according to the second metatarsal bone position determining device 1c according to the present embodiment, the second metatarsal bone position indication is performed in a state where the abutting plate 42 is in contact with the patient's internal and external fruits. The portion 18b is disposed at a position corresponding to the second metatarsal bone. At this time, the second metatarsal position indicating unit 18b is arranged based on the relative positional relationship between the patient's internal or external fruit and the second metatarsal. Thereby, the 2nd metatarsal position instruction | indication part 18b can be arrange | positioned correctly in the position corresponding to a 2nd metatarsal bone. And since the operator who performs artificial knee joint replacement can see directly the 2nd metatarsal position instruction | indication part 18b arrange | positioned as mentioned above, he can grasp | ascertain the position of a patient's 2nd metatarsal easily. can do.

  Therefore, according to the second metatarsal position determining instrument 1c, the position of the patient's second metatarsal bone can be easily specified. In addition, since the position of the second metatarsal position indicating unit 18b determined as described above is a position that accurately corresponds to the position of the second metatarsal bone, alignment can be obtained with high accuracy.

  Further, according to the second metatarsal bone position determining instrument 1c, the second metatarsal bone position indicating unit 18b is configured such that the abutment plate 42 is brought into contact with the external fruit of the distal end of the radius or the internal fruit of the distal end of the tibia. In this state, the second metatarsal is disposed at a position corresponding to the position of the second metatarsal, based on the positional relationship between the external fruit (or inner fruit) and the second metatarsal obtained in advance. These outer fruits and inner fruits are laterally protruding portions (so-called wrinkles) at the distal end of the lower limb, and are portions covered only by a very thin layer (skin etc.). That is, the relative positional relationship between the contact plate 42 that is in contact with the outer fruit (or inner fruit) via this thin layer and the second metatarsal bone position indicating portion 18b is determined in advance. Or, the relative positional relationship between the inner capsule and the second metatarsal is substantially the same. Thereby, the big position shift with the position of the 2nd metatarsal position instruction | indication part 18b and the actual position of the 2nd metatarsal can be prevented. Therefore, according to this configuration, the position of the second metatarsal can be accurately grasped.

  Further, according to the second metatarsal bone position determining instrument 1c, the second metatarsal bone position determining instrument is obtained by sandwiching the cautery of the distal end of the radius and the inner cautery of the distal end of the tibia by the pair of contact plates 42. 1c can be easily fixed to the patient.

  Further, according to the second metatarsal bone position determining device 1c, the external fruit of the patient's distal end (or the internal fruit of the distal end of the tibia) obtained in advance by modeling the bone part of the patient and the second medium Based on the positional relationship with the foot bone, the position of each contact plate 42 with respect to the reference position of the connecting portion 45 (the position where the second metatarsal position instruction portion 18b is provided) is adjusted. Specifically, the surgeon confirms the right scale part 46 or the left scale part 47 while determining the distance between the reference position and the contact plate 42 by modeling or the like. And the distance between the outer fruit (or inner fruit). Thereby, the position of the 2nd metatarsal position instruction | indication part 18b can be correctly match | combined with the position of a 2nd metatarsal bone.

  FIG. 13 is a view showing a state in which the artificial knee joint replacement instrument unit 9 according to the embodiment of the present invention is fixed to a patient. The artificial knee joint replacement instrument unit 9 includes the femoral position determining instrument 1 and the second metatarsal position determining instrument 1c described above.

  According to the artificial knee joint replacement instrument unit 9, for example, whether or not the center of the femoral head 56 of the patient P, the center of the knee joint, and the second metatarsal are straight during and after the operation. Can be confirmed. Specifically, the artificial knee joint replacement instrument unit 9 is used in a state in which both the femoral head position determining instrument 1 and the second metatarsal bone position determining instrument 1c are fixed to the postoperative patient P. Then, the surgeon attaches one end of the alignment rod 60 to the attachment hole 18a of the femoral head position determining unit 18 of the femoral head position determining instrument 1 and attaches the other end of the alignment rod 60 to the second metatarsal position determining instrument. It attaches to the attachment hole 18a of the 2nd metatarsal position instruction | indication part 18b of 1c. At this time, as shown in FIG. 13, if the center of the knee joint overlaps the alignment rod 60, the femoral head center, the knee joint center, and the second metatarsal center are aligned, that is, the alignment is It can be confirmed that it is taken. On the other hand, if the alignment rod 60 and the knee joint center are displaced, it can be confirmed that the alignment is not achieved, and the necessity of re-osteotomy can be determined according to the amount of displacement.

  The present invention can be widely applied as an instrument for grasping the position of a predetermined site (particularly, the femoral head or the second metatarsal bone) in a patient undergoing knee replacement.

1,1a, 1b Femoral head positioning instrument (artificial knee joint replacement instrument)
1c Second metatarsal bone positioning device (artificial knee joint replacement device)
2, 2a, 2b, 2c Holding mechanism 3, 3a Pointing mechanism 4, 4a, 40 Holding portion 6, 42 Contact plate (contact portion)
9 Artificial knee replacement device unit 18 Bone head position indicating unit (position specifying target indicating unit)
18b Second metatarsal position indicating unit (position specifying target indicating unit)

Claims (14)

A holding portion having an abutting portion that comes into contact with an abutting target of a patient undergoing artificial knee joint replacement, and held against the patient in a state in which the abutting portion is in contact with the abutting target A holding mechanism,
A position specifying target indicating unit disposed at a position corresponding to a position specifying target that is a part of the patient whose position is to be specified in the state where the holding mechanism is held with respect to the patient, and is attached to the holding mechanism; An indicating mechanism;
With
The position at which the position specifying target instruction unit is arranged is determined based on a positional relationship between the contact target and the position specifying target obtained in advance before the operation, and knee replacement Appliances. The artificial knee joint replacement device according to claim 1,
The abutment portion is provided with an abutment object recess into which the abutment object is fitted. The artificial knee joint replacement device according to claim 2,
The holding portion further includes an abutting portion mounting portion that is detachable from the abutting portion, and the abutting target is disposed in the abutting target concave portion of the abutting portion that is attached to the corresponding abutting portion mounting portion. A device for artificial knee joint replacement, characterized in that is fitted. In the artificial knee joint replacement device according to claim 2 or 3,
The prosthetic knee joint replacement instrument is characterized in that the contact object recess is formed according to the shape of the contact object in each patient. The artificial knee joint replacement device according to any one of claims 1 to 4,
The holding mechanism is
A pair of the holding portions;
A connecting portion that connects the pair of holding portions;
The prosthetic knee joint replacement instrument, wherein the holding mechanism is held with respect to the patient when the abutting portions of the pair of holding portions sandwich the pair of abutting targets. The artificial knee joint replacement instrument according to any one of claims 1 to 5,
An artificial knee joint replacement instrument characterized in that a hole for inserting an end of an alignment rod is formed in the position specifying target indicating unit. The artificial knee joint replacement device according to any one of claims 1 to 6,
The prosthetic knee joint replacement instrument is characterized in that the contact object is the left or right upper anterior iliac spine of the patient, and the position specifying object is the femoral head of the patient. The artificial knee joint replacement device according to claim 7,
The indicating mechanism has a proximal end portion which is a proximal end portion and a distal end portion which is a distal end portion,
The proximal end is attached to the holding mechanism;
The distal end portion is formed so as to extend in a direction away from the proximal end portion, and the position specifying target instruction portion is provided at the distal end of the distal end portion. Surgical instrument. The artificial knee joint replacement device according to claim 8,
The prosthetic knee joint replacement instrument is characterized in that the distal end portion is movable along the extending direction of the distal end portion with respect to the proximal end portion. The artificial knee joint replacement device according to claim 8 or 9,
The holding mechanism further includes a universal joint portion,
The prosthetic knee joint replacement instrument, wherein the base end part is attached to the universal joint part. The artificial knee joint replacement device according to any one of claims 1 to 6,
The abutment object is an external capsule of the distal end of the radius of the patient or an internal capsule of the distal end of the tibia, and the localization target is the second metatarsal of the patient, Knee replacement device. The artificial knee joint replacement device according to claim 11,
The holding mechanism is
A pair of the contact portions;
A connecting portion for connecting the pair of contact portions;
One of the abutting portions is in contact with the outer fruit of the distal end of the radius, and the other of the abutting portions is in contact with the inner fruit of the distal end of the tibia. The artificial knee joint replacement instrument is movable along the connecting portion. The artificial knee joint replacement device according to claim 12,
The position specifying target instruction unit is provided in the connecting unit,
The connecting portion is formed with a scale portion for measuring a distance between a reference position corresponding to the position where the position specifying target indicating portion is provided in the connecting portion and the contact portion. A device for artificial knee joint replacement. A femoral head positioning instrument as an artificial knee joint replacement instrument according to any one of claims 7 to 10,
The second metatarsal bone position determining device as the artificial knee joint replacement device according to any one of claims 11 to 13, further comprising a second metatarsal bone position determining device. Instrument unit.

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